We present a case of a 71-year-old woman suffering from mammary Paget,s disease and having a 10-years history of an irregular, widespread erosion accompanied by itching and burning on the skin of her left chest, extending to the breast. The erosion had steadily enlarged and had become increasingly tender. The nipple and areola of the left breast disappeared and could not be recognized. No abnormality of the right nipple, areola, and covering skin and no supernumerary nipple were seen. Mammography and ultrasonography could not be performed because of severe pain and erosive wetness. Histopathology of a surgical biopsy specimen showed epidermal infiltration by large, round, clear atypical cells scattered individually or in small clusters and distributed horizontally throughout the epidermis. The cytoplasm of these large cells was pale and vacuolated and was equivalent to that in nipple cells in Paget,s disease, and a diagnosis of mammary Paget,s disease was made. We performed total mastectomy of the left breast with wide excision of the Paget lesion of the left chest and axillary lymph node sampling. Histological examination of the specimen showed typical distribution of Paget,s cells; however no ductal carcinoma in situ was found in the mammary ducts and invasive growth was not recognized beyond the basal membrane of the lesion. From this evidences, we established a diagnosis of large, irregulaly shaped unusual mammary Paget,s disease, not of breast cancer origin, covering the left breast, areola, and nipple.
Abstract Gasdermin (GSDM/Gsdm) family was originally identified as a candidate causative gene for a mouse skin mutation, recombination induced mutation 3 (Rim3). It has four human homologs, GSDMA, GSDMB, GSDMC, and GSDMD. All GSDM family members are located in amplicons, genomic regions often amplified during cancer development, and are considered to be involved in the regulation of epithelial apoptosis. GSDMA is mainly expressed in the upper gastrointestinal tract. In contract, GSDMD is expressed in the colorectal tract. In this study, we researched those expressions in colorectal cancer and evaluated them for tumor marker, comparing between those expressions and clinical pathological status. We immunohistologically analyzed both expressions of GSDMA and GSDMD, using thirty colorectal cancer cases which were surgically treated at our institution 2013-2014 (Stage1 10 cases, Stage2 10 cases, Stage3a 10cases). Thenretrospectively analyzed the connection, between GSDM expression and clinicopathological data. GSDMA was no expressed in normal colorectal epithelium, but was overexpressed gradually rising in carcinoma. However, GSDMD showed the opposite results compared with GSDMA. The results of the expression analysis suggested that GSDMA and GSDMD act antagonictically with each other in the clinical stage of colorectal cancer. Citation Format: Hajime Orita, Shigekazu Tanaka, Shunsuke Watanabe, Hirokazu Matsuzawa, Konomi Mizuguchi, Tomoaki Ito, Koji Senuma, Tomoyuki Kushida, Mutsumi Sakurada, Hiroshi Maekawa, Ryo Wada, Koichi Sato. The efficacy of Gasdermin gene family for tumor marker in colorectal cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3424. doi:10.1158/1538-7445.AM2015-3424
A 77-year-old man presented to the Department of Internal Medicine with a chief complaint of abdominal pain. During the outpatient examination, a computed tomography (CT) scan showed gallstones. The patient developed worsening abdominal pain and fever and was admitted to the emergency department. He was diagnosed with cholecystitis and hospitalized. Treatment with antimicrobial agents was initiated. On the second day of hospitalization, the patient developed a fever of 39°C, hypotension, and oliguria. An emergency CT scan was performed, which showed gas production in the gallbladder. He was diagnosed with emphysematous cholecystitis, and emergency percutaneous transhepatic gallbladder drainage was performed. The patient was transferred to the high-care unit, and intensive care was initiated. On the eighth day, a follow-up CT scan showed an abscess in the gallbladder bed, and drainage was performed percutaneously. His general condition gradually improved, and he was discharged from the hospital on day 24. The patient was readmitted for cholecystectomy three months after the initial admission. The prognosis of sepsis caused by Clostridium perfringens is extremely poor, with a mortality rate of 70%-100%. We present a case of emphysematous cholecystitis successfully treated with multimodal treatment despite the presence of sepsis due to Clostridium perfringens and discuss the possible prognostic factors by reviewing the literature.
